Sequential small-molecule therapy for lymphocytic cicatricial alopecia: A multicenter prospective cohort pilot study.

Li, Yanhua; Shao, Guanghui; Tao, Qiuwei; Li, Yuqian; Wang, Yizhou; Zhu, Qilin; Zhu, Jing; Qiu, Sangsang et al. · J Am Acad Dermatol · 2026

prospective_cohort · Level II

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Abstract

Lymphocytic cicatricial alopecia (LCA) is a rare disorder causing irreversible hair follicle stem cell damage, with limited evidence supporting systemic treatments. To assess the efficacy and safety of a predefined three-stage sequential small-molecule therapy for active LCA. This multicenter prospective cohort pilot study enrolled adults with histopathologically confirmed active LCA at 3 Chinese tertiary centers. The regimen included oral Tofacitinib + topical Crisaborole (Stage I), oral Apremilast + topical Crisaborole (Stage II), and topical Crisaborole alone (Stage III). Primary outcomes were longitudinal Lichen Planopilaris Activity Index (LPPAI) and its improvement rate (ILPPAIS%). Of 33 patients, 31 completed the regimen. Baseline LPPAI (5.65 ± 1.45) decreased significantly to 0.75 ± 0.27 (ILPPAIS% 85.5%, P < .001) at Stage III; 93.5% achieved marked improvement with only 3 mild adverse events. Small sample size, lack of control group, and short follow-up. In this patient cohort, three-stage sequential regimen was well tolerated and offers a promising treatment option for active LCA.